Saturday, July 2, 2016

Retail Pharmacy, a REAL LIFE Game of Risk

Risk is a strategy board game produced by Parker Brothers (now a division of Hasbro). Winning Moves also makes a classic 1959 version. It was invented by French film director Albert Lamorisse and originally released in 1957 as La Conquête du Monde ("The Conquest of the World") in France. It was later bought by Parker Brothers and released in 1959 with some modifications to the rules as Risk: The Continental Game, then as Risk: The Game of Global Domination. See LINK

Risk is a turn-based game for two to six players. The standard version is played on a board depicting a political map of the Earth, divided into forty-two territories, which are grouped into six continents. The object of the game is to occupy every territory on the board and in doing so, eliminate the other players. Players control armies with which they attempt to capture territories from other players, with results determined by dice rolls.

If you haven't played Risk, let me clue you in. Risk isn't that much different than Checkers or Chess... the object being to dominate your opponent to win the game. A lot is determined by roll of the dice, but there is, however, strategy involved, just like with Checkers or Chess.

Retail Pharmacy, when you think about it, isn't much different than the game of Risk. Any one retailer wants to dominate the market because they want all the business. For example, Walgreens builds new stores everywhere, as does CVS, Rite Aid, and the rest of them. Sometimes there are acquisitions and mergers, such as Albertson's and Safeway merging groceries, and thus merging their respective pharmacies. Recently CVS acquired all Target pharmacies to increase their market share. That's how business works.

But here's ANOTHER WAY to look at my analogy... Retail Pharmacy is also a game of RISK.... that risk being the risk harm or death to the patient. The potential for harm exists in any type of business, but it is especially risky in any business that deals with healthcare, such as retail pharmacy.

In the game of risk, as mentioned, strategy minimizes the risk of land loss. From The official rulebook:

Three basic strategy tips for the classic rules:

1. Players should control entire continents to get the bonus reinforcement armies.
2. Players should watch their borders for buildups of armies that could imply an upcoming attack.
3. Players should build up armies on their own borders for better defense.


This fun game of strategy seems to get it, but The Authorities don't get it. You minimize risk by lining your borders with more troops. In pharmacy, you minimize risk by having more technician help. Why has this simple concept evaded the minds of The Authorities? It's so simple as to be laughable, but....

....there I was, a few weeks ago, ALONE in the pharmacy on an extremely busy day. I called the scheduling department. This had to be a mistake. We had known for SEVERAL MONTHS that all techs would be absent that day. We NOTIFIED our superiors of the need. We cried out from the wilderness for more troops months in advance!

"You don't have a tech today, Crazy, because there was no one to send you."

In other words, using #InstantTranslation, what scheduling was saying was "We're going to put the burden of patient safety entirely on you and we're willing to accept what happens if a big mistake is made."

Taking this risk is completely unnecessary, haphazard, and ridiculous. When is taking a bigger risk with patient safety EVER acceptable? 

Perhaps it was just poor planning on the part of The Authorities? Perhaps. That same day I worked alone I found out that a neighboring (and much slower) Goofmart Pharmacy not only had a technician on board protecting their borders, they also had an Intern from a pharmacy school. In other words, scheduling didn't think it necessary to move troops in a moment of need.

Or perhaps it is just a complete dysfunction of priorities within upper management in the grand tower? On that same fateful day, while pretending to be Superhero Pharmacist trying to fill medications for patients, the fax machine spit out a list of Medication Therapy Management and Medication Reviews. Within 30 minutes the Head Cheese Clinical Guy at the corporate towers called...

"Crazy, did you get the list of MTM and CMRs to review and complete?"

I was stunned. Here I am, working ALONE in the pharmacy. I've got scripts to type and scripts waiting in the e-script system. I've got blinking red lights telling me that I have phone-in scripts waiting to be heard on the voicemail. I have a half-counted script on the counter, labels everywhere for scripts yet to be filled. I have scripts filled and on the counter to be bagged and hung up in will-call. I have bottles of meds everywhere and a back counter with today's order still waiting to be put away. The phone is ringing and there is not one, not two, but three people at the register waiting to pick up meds, and this imbecile from corporate is asking me if I've had time to complete his list that he faxed over less than 30 minutes ago.

I told him I'd be really happy to look at it when we get technician help. I'm not sure he caught my sarcasm because I hung up.

As I stated, this happened a few weeks ago. To my knowledge, everyone survived... THIS TIME. But the risk of harm to the patient was put to full tilt, and I don't like being the one pressured to get it all right. 

Maybe it's time to try hospital pharmacy.


Anonymous said...

I've driven myself half insane trying to wrap my head around how corporate functions. I realized something recently.

We as pharmacists and technicians on the front lines, understand the business from the point of view of having to keep our moronic customers alive and avoiding mistakes so we keep our jobs. Very simple, right? We are healthcare providers that provide healthcare so our #1 priority is to be the best that we can possibly be.

Our fearless leaders at corporate, yes, even the ex-pharmacists, have stopped thinking that way. They've all drank the Wall St Kool Aid that tells them profit and growth are paramount. Take this scenario for example (real, by the way): profit margin has increased over 1% this quarter but pharmacist error rates (the ones that are caught and reported) have tripled in the same time period. As a pharmacist, that terrifies me because that 1% bump in profit came from cutting hours but maintaining and in some cases, increasing output which led to an increase in reportable errors. The attitude at corporate? Meh, the 'risk' is acceptable. Some idiot MBA crunched the numbers and somehow figured that the 'risk' of being sued and the amount that might be paid out in lawsuits is ok compared to the money they're raking in.

That's how these idiots think. They could give two sh!ts about patient safety. If it improves the bottom line, then they're all for it. Immunizations? Hell, giant admin fee leads to ginormous profit margins? Push those things til your voice gives out. MTM? We can bill for that sh!t now. Go go go! But try asking for more help or resources? Nope, that hurts the district's profit margin (and thus corporate's year end bonus) so nope, you get to crash and burn.

It makes me sad how this profession has changed with the spread of the cancer that is corporate pharmacy.

Anonymous said...

Well dude, leave. I did. They do that shit to you because you keep showing up.

Anonymous said...

Wish I could anonymous 1:50pm, I really wish I could.

Unfortunately, the job market in the area that I am tied to is saturated. Even if I could leave, I have too many obligations that keep my from telling my bosses to go play in traffic and just walk out the door.

That and the few decent people that do come to my pharmacy depend on me and the great people that work with me.

I will continue to fight but I feel that since there are so many new grads in the area willing to work for significantly less money, I'm one conscious objection away from losing my job.

Anonymous said...

The system asks if "you're a robot" before it allows you to post a comment. The correct answer is "no", isn't it? Just had a meeting with The Boss where he said we need to cut another 10% in tech hours. Also, we need to be more consistent in completing our monthly action plans that spell out how to improve our low "customer service" metrics. I bought a "countdown to retirement" clock and look at it daily...